‘People die at home’: Tigray medical services struggle after turmoil of war

By Reuters Staff

NAIROBI (Reuters) – A diabetic mother died as her daughter searched the capital of Ethiopia’s northern Tigray region for insulin. Women gave birth unattended in the dark because their hospital had no electricity or staff at night.

Accounts from residents, medical workers and humanitarian groups illustrate people’s plight as Ethiopia struggles to revive a heavily damaged healthcare system in Tigray three months after fighting erupted between the military and the region’s former ruling party, the Tigray People’s Liberation Front (TPLF).

Some hospitals are barely functioning, with no water, electricity or food, they said. Most were looted of medicines; staff members fled.

“The health system in Tigray is reportedly nearly collapsing,” the United Nation’s Office for the Coordination of Humanitarian Affairs (OCHA) said in a Feb. 4 report.

An assessment carried out this month by international aid agencies found that out of Tigray’s 40 hospitals, only 11 were fully functional. Fourteen were not working at all, nine were partly functioning and six were not assessed, the report said.

Ethiopian Health Minister Lia Tadesse said conditions were improving rapidly. The government has sent supplies to 70 of the region’s 250 health facilities, along with 10 ambulances, she told Reuters last week.

“So many health facilities have been looted, so we are working to get more equipment to the region,” she said. “The focus is to restore services, supporting health workers to come back and ensure they have the supplies.”

Prime Minister Abiy Ahmed declared victory over the TPLF two months ago, but details of the devastation have been slow to emerge as communications to the region remain patchy, and the government tightly controls access for journalists and aid workers. Reuters has not been able to visit the region and could not independently verify accounts provided by residents and medical workers.

Prior to the outbreak of fighting on Nov. 4, most people in Tigray had easy access to a hospital or clinic, according to the Ministry of Health.

The conflict disrupted basic services, including diabetes treatment and maternal care, leading to “too many preventable deaths,” the International Committee of the Red Cross said in a Jan. 27 statement.

Only 30 of the region’s 280 ambulances are still available, according to OCHA.

One woman described searching the northern Tigray town of Sheraro, on Dec. 22 for pills to prevent pregnancy after a friend told her she had been gang-raped by five men.

“Not a single worker was in the hospital,” the woman told Reuters by phone, saying she was too afraid to be identified. “The whole hospital was looted … Apart from the roof and doors, nothing was left.”

She tried a health center, but said it too had been looted.

SLOW RECOVERY

When French aid group Medecins Sans Frontieres (Doctors Without Borders) visited the northern city of Adigrat in mid-December, the hospital was mostly deserted, it said in statement last week. There were hardly any medicines, and no food, water or money.

Some injured patients were malnourished, the group’s emergency coordinator for Tigray, Albert Vinas, said in the statement.

Some services have since resumed, but the hospital still has no chemicals for its laboratory and no therapeutic food for malnourished children, an Ethiopian medical worker stationed there told Reuters on Saturday. He asked not to be identified, because he was not authorized to speak to journalists.

Hospitals in the towns of Adwa and Axum, in central Tigray, also had no electricity or water when MSF visited. All the medicines had been stolen from Adwa hospital and furniture and equipment broken, Vinas said.

“I saw people arrive at hospital on bicycles carrying a patient from 30 km (19 miles) away, and those were the ones who managed to get to hospital,” he said. “People die at home.”

MSF is now supporting four regional hospitals along with smaller health centers, and running mobile clinics in 15 locations.

RURAL AREAS OUT OF REACH

Most rural parts of Tigray remain out of reach to humanitarian groups because of continuing insecurity, or because they lack permission to go there, aid workers told Reuters. The TPLF withdrew from the regional capital Mekelle and major cities, but low-level fighting has continued in some areas.

Ethiopia’s Ministry of Peace said on Saturday that it was “moving with urgency to approve requests for international staff movements into and within Tigray” to ensure humanitarian assistance is expanded without delay.

A team from international aid group Action Against Hunger reached a town west of Mekelle for the first time on Jan. 23 and found it “pretty deserted”.

“We want to start having mobile health and nutrition clinics to operate in the rural areas,” the group’s country director Panos Navrozidis told Reuters, but added security was still fragile.

Staffing at medical facilities also remains a problem.

As many as 20 or 30 women were giving birth unattended daily in the central town of Shire because the hospital is not staffed overnight as healthcare workers are afraid of looters, an aid worker who visited last week told Reuters.

Almost all healthcare workers in Tigray had gone unpaid since the conflict began, a regional government report noted on Jan. 8, and three healthcare workers told Reuters last week they had still not been paid.

Health Minister Tadesse said money was being sent to local authorities as quickly as possible. Hospitals in Shire and Axum were functioning again, she said, although Adwa hospital remained out of service.

Help is coming too late for some.

One woman told Reuters her 55-year-old mother died in Mekelle on Dec. 4 after the family was unable to find insulin.

Mehbrit, who asked to be identified by one name for safety reasons, said she tried hospitals, the Ethiopian Red Cross Society and other diabetics, but no one had spare insulin.

For days, she said, she jolted awake each night to check her mother’s labored breathing.

“I was praying to God to bring mercy in the house,” Mehbrit said. “The insulin came 13 days after my mother died.”

U.S. House to pass nearly $500 billion more in coronavirus aid on Thursday

WASHINGTON (Reuters) – The U.S. House of Representatives will pass Congress’ latest coronavirus aid bill on Thursday, House Speaker Nancy Pelosi said, paving the way for nearly $500 billion more in economic relief amid the pandemic.

Pelosi, in an interview on MSNBC on Wednesday, said House lawmakers were ready to then move on to a fifth effort to continue tackling issues swelling from the outbreak that has crushed the nation’s economy and battered its healthcare system.

“We’ll pass it tomorrow in the House,” the California Democrat said.

The bipartisan $484-billion package, which passed the Republican-led U.S. Senate on Tuesday, includes an additional $321 billion for a previously set up small business lending program that quickly saw its funds exhausted.

It also includes $60 billion for a separate emergency disaster loan program – also for small businesses – and $75 billion for hospitals and $25 billion for national coronavirus testing.

Pelosi said she hopes the newly provided funds will be able to flow to strapped employers and others as soon as possible after U.S. President Trump, who has backed the bill, signs it into law.

“This is absolutely urgent,” she told MSNBC.

She also said a subsequent fifth aid package should also include money to protect U.S. elections and the U.S. Postal Service.

(Reporting by Susan Heavey; additional reporting by Lisa Lambert; Editing by Andrew Heavens and Nick Zieminski)

NYC hospitals 10 days from crisis as coronavirus cases explode: mayor

By Jonnelle Marte and Barbara Goldberg

NEW YORK (Reuters) – The mayor of New York City, the epicenter of the nation’s coronavirus epidemic, on Sunday described the outbreak as the biggest domestic crisis since the Great Depression and called for the U.S. military to mobilize to help keep the healthcare system from becoming overwhelmed.

“If we don’t get more ventilators in the next 10 days people will die who don’t have to die,” said Mayor Bill de Blasio, as the nation’s most populous city saw COVID-19 cases top 8,000 and deaths hit 60.

Nationwide, cases have topped 29,000 with at least 385 dead, according to a Reuters tally.  The number of cases of the highly contagious respiratory illness in the United States and Spain are exceeded only by China and Italy. Italy reported record numbers of daily coronavirus deaths last week.

“This is going to be the greatest crisis domestically since the Great Depression,” de Blasio told CNN, referring to the economic crisis of the 1930s. “This is why we need a full-scale mobilization of the American military.”

Nearly one in four Americans, or 80 million, were under orders to shelter at home as New York, California, Illinois, Connecticut and New Jersey instituted statewide lockdowns.

Around the globe, billions are adapting to a new reality, with countries like Italy, Spain and France on lockdown and several South American nations taking similar measures to try to stay ahead of the contagion, as global cases exceeded 300,000 and deaths top 13,000.

The lockdown affecting large segments of the American public to try to curb the spread of the coronavirus is likely to last 10 to 12 weeks, or until early June, U.S. Treasury Secretary Steven Mnuchin said on Sunday.

Lawmakers in Washington are nearing a deal that could pump a record $1 trillion into the economy to limit the economic damage from the coronavirus.

Speaking on “Fox News Sunday,” Mnuchin said the package would give an average U.S. family of four a one-time payment of $3,000.

MEDICAL CRISIS

De Blasio said the city is not getting needed medical supplies from the federal government to contend with the rapid spread of the sometimes deadly illness.

“If the president does not act, people will die who could have lived otherwise,” de Blasio told NBC.

Hospitals are scrambling for protective equipment for healthcare workers and for ventilators as they brace for a wave of patients who will need help breathing as severe cases often lead to pneumonia and decreased lung function.

New York Governor Andrew Cuomo urged the federal government to take over acquisition of medical supplies so states do not have to compete with each other for desperately needed resources. He also repeated a request for the Army Corps of Engineers to build temporary hospitals.

Over the past week, U.S. President Donald Trump’s administration has been pushing for aggressive steps to stem the economic hit, after Trump spent several weeks downplaying the virus’ risks.

Trump said on Twitter on Sunday that U.S. automakers Ford Motor Co, General Motors Co and Tesla Inc had been given the green light to produce ventilators and other items in short supply during the coronavirus outbreak.

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, on Sunday said the White House recognized the urgency of New York’s situation.

“Not only is New York trying to get resources themselves, but we’re going to be pouring it in from the federal government,” he told CBS News.

U.S. drugmaker Merck & Co Inc said it delivered 500,000 donated masks to New York City on Sunday morning.

The help is not coming quickly enough, Cuomo said.

“Time matters, minutes count, and this is literally a matter of life and death,” he said.

He also chastised New York residents who were congregating in parks and other places and not practicing social distancing. He noted 53% of the cases in New York are between the ages of 18 and 49.

“It’s insensitive, arrogant, self-destructive…and it has to stop, and it has to stop now,” he said. “This is not a joke and I’m not kidding.”

(Reporting by Jonnelle Marte and Barbara Goldberg in New York; Additional reporting by Andrea Shalal and Susan Heavey in Washington; Writing by Lisa Shumaker; Editing by Bill Berkrot)

Venezuela healthcare collapse: Four children die in same hospital this month

Relatives carry a coffin containing the body of Erick Altuve, a 11-year-old boy who died from respiratory problems while in care for stomach cancer at the public Jose Manuel de los Rios hospital, at Petare neighborhood in Caracas, Venezuela, May 30, 2019. REUTERS/Ivan Alvarado

By Vivian Sequera

CARACAS (Reuters) – Under a wooden arch decorated with white balloons in a small house in Caracas’ largest slum, the body of 11-year-old Erick Altuve lay in a small coffin covered in cuddly toys and cartoon drawings, one of four children who have died this month in Venezuela’s main pediatric hospital.

Altuve died on May 26 from respiratory problems while being treated for stomach cancer at the Jose Manuel de los Rios public hospital, a concrete tower ringed by a white security fence in the center of Caracas.

For the past six months, Altuve had not received his medication, his mother, Jennifer Guerrero, said, because of widespread shortages of drugs and medical equipment that have devastated Venezuela’s health system.

“My son really wanted to live,” said Guerrero, a 30-year-old housewife, during a protest over the deaths of the four children by their relatives and nurses outside the hospital.

Children have paid an especially heavy price from the collapse in Venezuela’s healthcare system as the economy has shrunk by over a half during six years of recession.

The most recent figures from Venezuela’s Health Ministry show that infant mortality, covering children age 1 and below, rose 30% to 11,466 cases in 2016 from the year before. There is no official data on children’s’ deaths from cancer.

More broadly, the mortality rate for children under 5 years has risen by 40% since 2000, the humanitarian group Save the Children said in its 2019 report.

Altuve’s death in particular has generated a wave of anger and grief across Venezuela, with outraged newspaper headlines, calls from the opposition for an investigation and an outcry from medical nongovernmental organizations.

Altuve and the three other children who died were part of a group of 30 kids at the hospital, better known as JM, waiting to go to Italy to receive bone marrow transplants under a 2010 agreement financed by the Venezuelan government that was intended to cover the cost of transportation and the operation.

The opposition has blamed their deaths on President Nicolas Maduro, whose socialist administration has presided over the collapse of the once-wealthy nation’s economy and severe reductions in health-care spending.

Maduro’s government, however, says U.S.-imposed sanctions were responsible for the children’s deaths, by freezing funds allocated to buy medicine and send the children to Italy for treatment under the 2010 agreement.

Maduro’s critics noted that his government in 2013 cut the allocation of foreign currency to the health sector by one-fifth.

According to hospital and pharmacy representatives, the supply of medicine and medical equipment has steadily declined since the cuts to dollar funding in 2013, while the U.S. government began to impose sanctions in August 2017.

Virginia Segovia, president of the Foundation to Help Children with Cancer (Fundanica) in Carabobo state west of Caracas, said that in its first 22 years, the charity registered 98 child deaths from the disease in that region.

“In the past two years, we already have 105 dead children … and that is due to the lack of supplies and equipment in hospitals, the extreme emergency we have due to lack of medicines and chemotherapy,” she said.

Venezuela’s Information Ministry, which handles news media inquiries, and the health ministry did not respond to requests for comment.

‘SENTENCED TO DEATH’

Altuve was taken to the JM hospital on Dec. 25, 2018, due to a sharp pain in his stomach, his mother said. The hospital cleared him to go home after a few days but he returned on Jan. 14, 2019 and never left, according to his mother.

“He was saying that he was going to get better and the cancer wouldn’t take him,” his mother said.

On Friday, dozens of mourners carried his coffin through the narrow streets of Caracas’ eastern Petare slum from his grandparents’ house where the wake was held to a cemetery outside the city.

Children from his school clustered around to say goodbye as speakers played Vallenato, accordion-based music from Colombia’s Caribbean coast. “Erick, one more angel in heaven,” read a note on the coffin.

Venezuelan Foreign Minister Jorge Arreaza said on Monday that state-run oil firm PDVSA had signed a cooperation agreement in 2010 with Italy’s bone marrow transplant association. State-funded Venezuelan television network Telesur reported on Tuesday that the agreement had funded treatment and transplants for almost 900 patients since then.

Arreaza said on Twitter that U.S. sanctions had frozen 1.6 billion euros ($1.78 billion) of government funds held at Portugal’s Novo Banco, including 5 million euros ($5.57 million) allocated for fund bone marrow transplants for 24 Venezuelan patients.

Novo Banco and the Italian transplant association did not respond to requests for comment.

There are 52,800 new cases of cancer among adults each year in Venezuela, which has a population of 30 million people, according to Juan Saavedra, director of Venezuela’s anti-cancer society. In 2017, 26,510 people died from cancer, 15% more than the year before, Saavedra said.

“When you are born in Venezuela, you are already sentenced to death,” said Mauricio Navas, whose six-year-old daughter Mariana is being treated for leukemia at the JM hospital.

(Additional reporting by Tibisay Romero; Writing by Angus Berwick; Editing by Daniel Flynn and Jeffrey Benkoe)